Neuroleptic Malignant Syndrome

Neuroleptic malignant syndrome (NMS) is not a primary disease but rather a complication of what has been supposed to be a therapeutic regimen. It is a fatal complication of treatment with potent neuroleptics (anti – psychotic drugs and anti –schizophrenic drugs which inhibits dopaminergic receptors or blocks serotonin receptors). NMS usually occurs when the treatment was initiated. It has been said that the drug’s potential for stirring up neuroleptic malignant syndrome seems to parallel its antidopaminergic activity.

Causes:

Medications

The following medications are what usually predispose onto having NMS. The potent drugs are the following:

Monoamine oxidase inhibitors

Anticonvulsants

Lithium

Haloperidol

Phenothiazines

Butyrophenones

Thioxanthenes

Benzamines

Dopamine antagonists

Tricyclic antidepressants

External factors

Sudden or rapid administration of drugs

Usage of high potent neuroleptic drugs

Risks

The following are the risks factors that may be attributed into having NMS:

Concurrent use of predisposing drugs (those listed above)

Severe patient agitation

Organic brain disease

Dehydration

Affective disorder

Alcoholism

Nutritional deficits or Malnutrition

Catatonia

History of neuroleptic malignant syndrome

Manifestations:

Patient with neuroleptic malignant syndrome may present the following signs and symptoms:

Hyperthermia

Altered mental status

Rigidity

Extrapyramidal syndrome (EPS)

Tachycardia

Dysphagia

Hypoxemia Urinary incontinence

Tachypnea

Hypotension

Diaphoresis

Dyspnea

Dysrhythmias

Assessment and Diagnosis

It is unfortunate that there is no laboratory test result that will verify neuroleptic malignant syndrome (NMS). These findings however will aid the physician into considering the presence of NMS:

Neuroleptic malignant syndrome (NMS) is an emergency situation that warrants quick intervention and apt monitoring and management. Treatment will depend upon the severity of the disease.

If neuroleptic malignant syndrome is suspected, high potential drugs that are said to induce NMS should be withdrawn from the regimen. It should be stopped or else, the disease might progress and may cause fatalities.

Hyperthermia is common so provide ventilation, render tepid sponge bath and administer anti-pyretics as ordered.

If infection is suspected, start antibiotic treatment as ordered.

Be ready with prophylactic intubation especially if patients have:

Excessive salivation

Acidosis

Severe rigidity

Swallowing dysfunction

Hypoxemia

Monitor laboratories and refer any significant findings and unusualities to the physician.